The Increase in Number of Orchidopexies: Rather Cause than Prevention of Male Infertility/Der Anstieg der Orchidopexie: Eher Ursache als Vorbeugung der Infertilität des Mannes

Because of the present tendency to operate early on undescended testes, the indication for orchidopexy amounts to six-to-seven times the justified number in the Netherlands and two-to-three times in Flanders! The tendency to operate early has surely caused more fertility damage than prevented it. This critical statement asks for consideration and urges everybody concerned to a more accurate and repeated physical examination of the genital region and to a conservative attitude regarding treatment.     

Effect of Simultaneous Local Injection of 6-Hydroxydopamine and Naloxone on the Testis of Neonatal Rats/Der Einfluß einer gleichzeitigen lokalen Injektion von 6-Hydroxydopamin und Naloxon auf den Hoden neugeborener Ratten

The effect of simultaneous intratesticular injection of the opiate receptor antagonist naloxone and the neurotoxic drug 6-hydroxydopamine (6-OHDA) on testicular growth, compensatory testicular hypertrophy, serum testosterone level and basal testosterone secretion in vitro was studied in neonatal rats. In animals with two testes unilateral intratesticular administration of naloxone alone enhanced, while 6-OHDA alone decreased the weight of the treated gonad. In animals treated simultaneously with these two agents the decrease in testicular weight induced by 6-OHDA was partially prevented by naloxone. In hemicastrated animals intratesticular treatment with naloxone enhanced the extent of compensatory testicular hypertrophy. Treatment of the remaining testis with 6-OHDA + naloxone did not interfere with the diminished compensatory testicular hypertrophy observed following 6-OHDA treatment. Data indicate that naloxone can counteract the degenerative effect of 6-OHDA in animals with two testes but not in hemicastrates.     

Relationship of Sperm Acrosin Activity to Semen and Clinical Parameters in Infertile Patients/Die Beziehung der Akrosinaktivität zu verschiedenen Sperma- und klinischen Parametern bei infertilen Patienten

Acrosin activity (aa) was routinely measured in 189 infertile men who attended the hospital between March 1984 and January 1985. The evaluation of the male included semen analysis, microbial screening, postcoital testing (PCT), in vitro sperm penetration test (SPMT), and screening for anti-sperm antibodies in serum. The strongest positive correlations of aa were found for sperm motility, count, morphology, vitality and volume. In presence of a poor PCT result, aa was significantly reduced, even in patients with good motility in native semen. A similar result was obtained with the SPMT: reduced sperm density and poor sperm motility in the capillary after 2 hours were significantly correlated to reduced aa. Smokers exhibited lower aa in presence of normal sperm count and motility. In the infertile group aa was significantly lower than in the group of men whose spouses conceived. On the basis of our results, the routine determination of aa is not necessary, but it provides additional prognostic information in couples with unexplained infertility.     

Testicular Tumour Size and Rete Testis Invasion as Prognostic Factors for the Risk of Relapse of Clinical Stage I Seminoma Testis Patients Under Surveillance: a Systematic Review by the Testicular Cancer Guidelines Panel

Context

Patients with clinical stage I (CS I) seminoma testis with large primary tumours and/or rete testis invasion (RTI) might have an increased risk of relapse. In recent years, these risk factors have frequently been employed to decide on adjuvant treatment.

The Effect of Non-Union of Testis and Epididymis and of Cryptorchidism on the Development of Epididymis and Ductus Deferens in the Rat/Der Einfluß der Separation von Hoden und Nebenhoden und des Kryptorchismus auf die Entwicklung von Nebenhoden und Ductus deferens bei der Ratte

16-days old rats were operated with either uni- or bilateral ligation of ductuli efferents and separation of testis and epididymis to the level of the inferior epididymal artery (non-union operation), induction of cryptorchidism or bilateral sham operation. The epididymides were weighed and the epididymides and deferent ducts were examined with light- and electron-microscopy at days 30, 37, 44 and 58. Bilateral non-union operated epididymides and cryptepididymides had a significantly lower weight increase than controls, but the histology and diameter of epididymal tubules were unchanged. This indicates a true growth retardation and reduced length of epididymal tubules of non-union operated and cryptepididymides. For bilateral operations a positive correlation was found between the weight of epididymis and plasma levels of total testosterone as reported earlier. Unilaterally operated epididymides had a weight development significantly below contralateral controls, despite normal plasma levels of testosterone. It is concluded that the reduced-weight of unilaterally operated epididymides is the result of diminished local androgen stimulation from the ipsilateral testis. Non-union of testis and epididymis may have pathogenetic significance in maldescent of testis by a retarded growth of the ductal system.     

中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后相关症状和审美评价的影响因素分析

目的:分析中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后患者出现相关症状(瘢痕遗留、色素沉着、局部红斑)的影响因素,了解人群中对中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后影响审美评价的相关因素。方法:回顾性分析在笔者医院皮肤科应用1064nm波长可调脉宽Nd∶YAG激光治疗的89例中重度痤疮患者的临床资料。选取100名外貌正常,具备完整审美能力的普通人作为评价者,根据李克特量表对患者形象进行评分。采用单因素分析和多元Logistic回归模型分析中重度痤疮激光治疗后相关症状和审美评价的影响因素。结果:单因素分析显示,年龄、性别、BMI、吸烟、皮肤类型、初发年龄、病程、发病部位、家族史、伴发病、蠕形螨、尘螨SPT、瘢痕体质均是中重度痤疮激光治疗后相关临床症状的影响因素(P<0.05)。评价者年龄、学历,患者年龄、BMI、皮肤类型、发病部位、瘢痕厚度和瘢痕柔软度是审美评价的影响因素(P<0.05)。多因素Logistic分析显示,性别、家族史、伴发病、蠕形螨及尘螨SPT是中重度痤疮激光治疗后相关症状的独立影响因素(P<0.05)。评价者年龄、患者BMI、皮肤类型和发病部位均是审美评价的独立影响因素(P<0.05)。结论:中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后相关症状与性别、家族史、伴发病、蠕形螨及尘螨SPT有关。中重度痤疮1064nm波长可调脉宽Nd∶YAG激光治疗后的审美评价与评价者年龄,患者BMI、皮肤类型和发病部位有关。     

Salvage Cryosurgery of the Prostate for Failure After Primary Radiotherapy or Cryosurgery: Long-term Clinical,Functional, and Oncologic Outcomes in a Large Cohort at a Tertiary Referral Centre

Background

Salvage cryosurgery (SC) is a recognised option for patients who fail either primary radiation or cryosurgery.

Objective

To report outcomes of patients undergoing SC.

Design, setting, and participants

A consecutive series of 396 patients who had failed either primary radiotherapy or cryosurgery underwent SC between October 1994 and August 2011.

Outcome measurements and statistical analysis

Demographic and clinical parameters before primary and salvage treatment were evaluated; disease-free-survival (DFS), overall-survival (OS), disease-specific-survival (DSS), and complications were assessed.

Results and limitations

Sufficient follow-up data were available for 328 patients. Median age was 65.8 yr (range: 45–81 yr), median serum prostate-specific antigen (PSA) level was 8.0 ng/ml (range: 0.6–290.0 ng/ml). After primary treatment, median time to recurrence was 55 mo (range: 0.0–183.6 mo). SC was performed at a median of 67.5 mo (range: 7.0–212.7 mo) later; median pre-SC PSA level was 4.0 ng/ml (range: 0.1–112.4 ng/ml). Median PSA nadir was 0.2 ng/ml (range: 0.01–70.70 ng/ml), reached after a median of 2.6 mo (range: 2.0–67.3 mo) after SC. Median follow-up was 47.8 mo (range: 1.6–203.5 mo). Respective 5- and 10-yr DFS was 63% and 35%; OS: 74% and 45%; and DSS: 91% and 79%. In univariate analyses, time from primary treatment to SC or recurrence, PSA level before SC, and PSA nadir after SC were all significant predictors of recurrence (p ≤ 0.01). PSA before SC and time to recurrence were also predictive of DSS (p = 0.003 and p = 0.01, respectively). In multivariate analyses, only PSA nadir after SC was predictive of recurrence and DSS (p < 0.001 and p = 0.012, respectively). Complications were rare (range: 0.6–4.6%). Fifty-five patients (16.7%) underwent focal SC. Median PSA nadir after focal SC was 0.44 ng/ml (range: 0.04–20.1 ng/ml). Twenty-seven patients (49%) experienced recurrence. Respective 5- and 10-yr DFS was 47% and 42%; OS: 87% and 81%; and DSS: 100% and 83%.

Conclusions

Our analysis confirms SC as an effective treatment option for patients failing primary therapy. Patients experienced excellent survival outcome and minimal associated morbidity after SC. Focal SC is an efficacious treatment for properly selected patients.